Skull reconstruction to close a chapter of his life

Car accident

In November 2013, Stefan, a healthy young man, got off the road for unknown reasons and hit a tree. This accident caused severe traumatic brain injury with a sub- and epidural hematoma, a hemorrhage behind the ear, a broken clavicula, bruised ribs and longs and an extensive fracturing of the neuro cranium and viscerocranium on the right side. He was kept in an artificial coma and underwent surgery that same night; a craniotomy of the right side, with removal of the hematomas and placement of an internal barometer and a lateral canthotomy and cantholysis were carried out.

After 5 days of intensive care, he had a long stay in the hospital and revalidation center and underwent an additional surgery for a wound revision and closure of the dura. He experienced several complications as meningitis and wound infection.

So after a turbulent recovery time of 3 months, on February 12th 2014 it was finally time for his skull reconstruction with his own bone piece. Although several treatments for wound leakage were needed, it seemed to go well for a while.

PMMA Implant

Half a year later however more pain came up, caused by the resolving of the replaced bone tissue. This lead to the decision to fill the defect with a PMMA implant in September 2014. This PMMA implant was “custom-made” by mixing bone cement intraoperatively in a pre-made mold. After this the patient still had severe headaches, diminishing of senses, as well the implant fixations were clearly visible through the skin. Also the shape of the implant did not properly reconstruct the original anatomy; a disappointing esthetic result.

CT imaging of the skin with PMMA implant
Photo of Stefan with PMMA implant

Additionally the head wound didn’t close leading to infections and inherent antibiotic treatments and eventually a need for again an extra surgery, in November 2014, for wound revision and adjustment and ablution of the implant.

Almost half a year after this last surgery again a bacterial infection was detected in March 2015.

Patient Specific Implant (PEEK) by Xilloc

Having had these disappointing experiences and outcome, as well functionally as esthetically, after so many treatments and surgeries spread over more than 1.5 year, Stefan contacted Xilloc for a patient specific PEEK implant. Xilloc forwarded Stefan to a client surgeon. Together with this surgeon, Xilloc designed the implant to perfectly fit the defect edge, with a temporal spacing to assure correct and simple placement. Tangential screw fixations were provided for an accurate and esthetically nice result and XSuture holes were foreseen to attach the dura and temporal muscle.

PMMA implant fixed with craniofix
PEEK PSI with tangential fixation and XSuture
PMMA implant: too thick and bulky
PEEK PSI: perfect fit and symmetry
Retrieved PMMA implant on a model of the defect
PEEK PSI on the same defect model

Satisfied surgeon, happy patient

The surgeon was very pleased with the implant, surgery and final result. The esthetic outcome made the patient smile again. Even neurologic improvements were noticed by the patient, which made him and his loved ones very happy!

“Really superb! I’m very happy with the prosthesis”

“After a lot of skull surgeries, which kept on going wrong, caused infections or were aesthetically not nice, I came in contact with Maikel. He completely understood my story and has helped me to receive a Xilloc implant in one of their client hospitals!
Neurological and aesthetically a world of difference!!! I got lots of compliments from friends and family that I look better now and that I even look more like myself in terms of behaviour.
I’m very satisfied! I regularly receive messages from Maikel and Erik; it’s very pleasant how they interact with their patients.”